Epilepsy Currents

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Epilepsy Currents Podcasts will bring you all the features you know and love about the journal in an innovative format you can take with you wherever you go. The primary content of Epilepsy Currents consists of commentaries written by our expert editorial board on recent high-impact research papers in Epilepsy. Each podcast episode will highlight one of these recent publications and the accompanying commentary. High-yield topics of interest to our engaged epilepsy community will be presented and discussed by one of our contributing editors and the original authors to give you an in-depth, rigorous, and personal view of current topics in epilepsy and the people behind them. Topics will include both clinical and basic sciences, emphasizing bringing our larger community together around the mission we share: To advance research, education, and practice for all professionals working in epilepsy.

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  1. 2025. 07. 29.

    Epilepsy Currents - Episode 10 -"The Impact of Perceived Epilepsy Stigma"

    Join Dr. Marawar in a conversation with Dr. Danielle Becker and Dr. Martha Sajatovic, as they discuss the article, "The Impact of Perceived Epilepsy Stigma" Click here to read the article. This podcast was sponsored by the American Epilepsy Society through a grant from the Centers for Disease Control (CDC). This activity is supported by the Centers for Disease Control and Prevention of the U.S. Department of Health and Human Services (HHS) as part of a financial assistance award totaling $1,500,000 with 100 percent funded by CDC/HHS. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by CDC/HHS, or the U.S. Government.   We'd like to acknowledge Epilepsy Currents podcast editor Dr. Adriana Bermeo-Ovalle, contributing editor Dr. Rohit Marawar, and the team at Sage. Summary In a baseline analysis from the CDC-funded SMART self-management trial, Dr. Martha Sajatovic's team evaluated 120 adults with uncontrolled epilepsy using the 10-item Epilepsy Stigma Scale. Higher perceived stigma was not tied to seizure frequency or most demographics; instead it clustered around a short list of modifiable factors: being single, receiving little social support, scoring low on the Epilepsy Self-Efficacy Scale, and reporting poorer day-to-day functioning. Dr. Danielle Becker's accompanying commentary argues that these "big three" drivers—self-efficacy, social isolation, and depression—form a hidden clinical burden as real as any EEG abnormality and should be addressed as routine vitals in epilepsy care. Both authors highlight peer-led programs such as SMART, which blend nurse facilitation with a trained person-with-epilepsy co-leader, as a scalable way to lift self-confidence, expand support networks, and ultimately blunt stigma's impact. Key Takeaways Core Correlates of Stigma: In the SMART cohort, the strongest independent predictors of high stigma scores were low social support, low self-efficacy, and poorer functional status; seizure count and most demographic variables showed no significant link. Self-Efficacy Is Central—and Modifiable: Lower confidence in managing seizures (self-efficacy) tracked closely with higher stigma. Boosting patients' belief that they can control triggers, medications, and disclosure decisions is a direct route to stigma reduction. Depression Magnifies Stigma's Weight: Undiagnosed or undertreated depression deepens perceived stigma and worsens quality-of-life scores, underscoring the need for systematic mood screening and at least initial SSRI therapy while specialty referrals are arranged. Peer-Led Self-Management Programs Work: Evidence-based curricula such as SMART (eight weekly Zoom sessions co-led by a nurse and a trained person with epilepsy) consistently raise self-efficacy scores, increase rescue-plan use, and shrink stigma—benefits that persist when agencies or clinics adopt the program. Clinic & Policy Action Points: Ask about stigma, self-efficacy, and mood at every visit; offer a printed or electronic referral to a vetted self-management course or local support group; and advocate for payer coverage of these programs so that addressing stigma becomes as routine—and reimbursed—as ordering an MRI.   Dr Rohit Marawar (Host): [00:00:00] Picture this scenario. Two patients leave clinic on the same day. One with excellent seizure control, yet feeling ashamed to mention their diagnosis. The other with daily seizures, but surrounded by supportive friends who see them not their epilepsy. Those contrasting stories sit at the heart of today's conversation about stigma and invisible force as real as any spike and view on an EEG.  Welcome to Epilepsy Currents podcast, the podcast for Epilepsy Currents Journal, exploring the latest research and expert commentaries from the world of epilepsy. I'm your host and associate editor for the podcast, Rohit Marwar. To unpack why stigma still sticks, and more importantly, what we can do about it. We are joined by two leading voices. First is Dr. Martha Stoic, first author of the article, clinical Correlates of Perceived Stigma Among People Living With Epilepsy, enrolled in a Self-Management Clinical Trial. Published in Epilepsy and Behavior Journal in [00:01:00] 2024. She's a professor and director of the Neurological and Behavioral Outcome Center, university Hospitals, Cleveland Medical Center in Cleveland, Ohio. Welcome Dr. Wick. Dr Martha Sajatovic: Thank you. Dr Rohit Marawar (Host): Then we have Dr. Daniel Baker, whose commentary, the stigmatizing impact of perceived epilepsy stigma. Puts those findings in a broader public health frame. Dr. Becker is the division director of epilepsy and associate professor of neurology at the Ohio State University Wexner Medical Center. Welcome, Dr. Becker. Dr Danielle Becker: Thank you for having me. Dr Rohit Marawar (Host): Great to have both of you on our podcast today. Let's dive in. To kick things off, Could you give us a quick elevator pitch of your study, who you enrolled, what you measure, and the takeaway finding our listeners should remember? Dr Martha Sajatovic: Yes. Thank you. I'm happy to talk about that. So, this analysis comes from a larger parent study. That was funded by the Centers for Disease Control and Prevention, or CDC. we are part of a, network called the Managing [00:02:00] Epilepsy Well or MU Network, which has been supported by the CDC for many years. The goal of the MU network is to develop, and test, evidence-based epileptic self-management. Curricular programs. This, analysis came from one of our randomized clinical trials that we are doing, testing a program called the Smart Epilepsy Self-Management, program. In this analysis, we focused just on baseline data. So we weren't looking at outcomes, but we were interested in looking at the correlations or the associations between, perceived stigma. So stigma that people, perceive people with epilepsy perceive in relation to demographic and other, clinical variables. So, basically we found that, stigma was related to, not very many demographic variables, really just, not being married or, cohabiting, but we did find that, higher levels of stigma were associated with. Less social support. So I was thinking of that in the little scenario that you gave, lower, scores [00:03:00] on a standardized rating of self-efficacy and lower functioning as well. So, there's appears to be that inverse, relationship. Dr Rohit Marawar (Host): Dr. Becker, you call stigma a hidden burden in your commentary from your vantage point, what does the burden look like in the everyday lives of people living with epilepsy in 2025? Dr Danielle Becker: Thank you. So I do wanna say that I think this hidden burden is not only on our patients, but also on the caregivers. Both the patients and the caregivers live with fear that a event or a seizure can happen at any time, and we know that that's associated with significant emotional burden. This emotional burden leads to both mental and physical health. It leads to anxiety and depression. We also know that it affects opportunities for patients with employment, with education, with developing social relationships. So in all we know that it, really is impacting mental health and we really, through this commentary and through Martha's. Paper and [00:04:00] work with the smart program. We know that when you have depression, especially undiagnosed depression, it worsens stigma and really that is a heavy burden on our patients and caregivers. Dr Rohit Marawar (Host): Well said, Dr. Vic. We hear the terms stigma and perceived stigma to. Around, and I think you also mentioned that just now, but how do you separate the two and why did you land on the 10 item epilepsy stigma scale? To capture it, Dr Martha Sajatovic: so that's a really excellent question. There are actually different types of stigma. if you look at the stigma literature, so there's, felt stigma, you know, if I am going to discriminate against you, sometimes called proceed stigma. there's, what we. As individuals get from our society or from those who are close to us, how do we get treated or discriminated against? there's also a, internalized stigma. Where were people? you know, if you tell something to somebody often enough that's negative [00:05:00] about themselves, often, eventually they will start to believe that. So what we are really looking at is a standardized scale. So there aren't actually that many specific, epilepsy stigma scales around. Rather, this was one that had already been tested and used, and we, thought would be generalizable to, the other literature. So what do people with epilepsy experience and what do they perceive? Dr Rohit Marawar (Host): Okay, great. and I'll stay with you Dr. So. We have moved away from the term epileptic people to the more app appropriate term persons with epilepsy or people with epilepsy. I noticed that you use the term people living with epilepsy in this study, which was a first for me. Why did you use that term, and why is that wording choice important in the fight against stigma? I. Dr Martha Sajatovic: Thank you for noticing that and appreciate that. so the goal here is that we really want to have the language that we are using be very person centered, right? in the smart program, which we'll probably talk about in a, couple [00:06:00] minutes, but, we really stress the. The point that you are a person that's living with epilepsy, you are not epilepsy. And epilepsy may impact your life in substantial ways often, but you are still an individual. You have stresses, you have joys. and so really anything that helps reinforce that, you are not this disease. Your person living with epilepsy is, extremely important. And over time, I think. Words matter. If we use words in ways that are appropriate and uplift people rather than grind them down, hopefully we can eventually win this battle against stigma.

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  2. 2024. 12. 17.

    Epilepsy Currents - Episode 9 - "Genetic Testing in Epilepsy: Improving Outcomes and Informing Gaps in Research"

    Join Dr. Bermeo in a conversation with Dr. Elizabeth Gerard, and Dr. Christa Habela, as they discuss the article, " Genetic Testing in Epilepsy: Improving Outcomes and Informing Gaps in Research ". Click here to read the article. This podcast was sponsored by Marinus Pharmaceuticals. We'd like to acknowledge Epilepsy Currents podcast editor Dr. Adriana Bermeo-Ovalle, contributing editor Dr. Rohit Marawar, and the team at Sage. In episode nine of the Epilepsy Currents podcast, Dr. Adriana Bermeo discusses the evolving role of genetic testing in epilepsy with Dr. Krista Habela and Dr. Elizabeth Gerard. They explore how genetic insights are enhancing diagnosis and treatment, highlighting the rapid advancements and future potential of this field. Key Takeaways Technological Advances: Since the first epilepsy gene discovery in 1997, technological advancements such as next-generation sequencing have dramatically accelerated gene identification, enhancing genetic testing's accessibility and effectiveness. Basic Genetic Concepts Clarified: Dr. Gerard explains critical genetic components—genes, chromosomes, and exomes—and their relationship to different genetic tests, providing a foundational understanding crucial for grasping how genetic variations impact epilepsy. Diagnostic Yield and Personalized Treatment: Genetic testing varies in diagnostic yield based on patient-specific factors like age of onset and associated conditions. Higher yields in targeted groups underscore its role in developing precise, personalized treatment plans. Impact on Patient Understanding and Future Testing: Genetic testing not only aids in diagnosis but also provides patients and caregivers with valuable explanations for the conditions, reducing uncertainty and informing better treatment choices. The future of genetic testing in epilepsy includes potential advancements in gene therapy and precision medicine, aiming to develop targeted treatments based on specific genetic profiles. Overcoming Barriers to Integration: Challenges like insurance coverage, the availability of genetic counseling, and the need for provider education must be overcome as genetic testing becomes integral to standard epilepsy care. This integration promises to streamline diagnostics and potentially reduce the need for other invasive tests.   Adrianna Bermeo-Ovalle, MD (Host): Why do I have epilepsy? What causes epilepsy? Are my children or other family members at increased risk of developing epilepsy as well? These are some of the most frequent questions I hear in the clinic these days. In a healthcare environment which turns more and more towards personalized medicine, genetics presents a unique opportunity to answer some of our patients most pressing questions. Today, we will explore the current indications and use of genetic testing in epilepsy and we'll take a peek into the future of epilepsy diagnosis and care.  Marinus Pharmaceuticals is the proud sponsor of episode number nine of Epilepsy Currents podcast. I am your host, Adriana Bermejo. I am the senior podcast editor for Epilepsy Currents, the official journal of the American Epilepsy Society. Let me first welcome Dr. Christa Habela. Dr. Habela is a Child Neurologist, Epileptologist, and the Director of the Long Term EEG Monitoring Program and the Epilepsy Genetics Clinic at the John Hopkins Hospital in Baltimore, Maryland. Dr. Habela is the author of the review, Genetic Testing in Epilepsy, Improving Outcomes and Informing Gaps in Research. This article was published online first on March of 2024 in Epilepsy Currents. Dr. Habela, thank you for joining us today. Christa Whelan Habela, MD, PhD: Thank you so much for having me. Host: It is also my pleasure to welcome Dr. Elizabeth Zoe Gerard. Dr. Gerard is an Associate Professor of Neurology at the Northwestern Feinberg School of Medicine and the Founding Director of the Women in Epilepsy Program, as well as the Adult Epilepsy Genetics Clinic at Northwestern. Dr. Gerard, thank you for being with us. Elizabeth E. Gerard, MD: Thank you so much for having me. It's my pleasure to be here. Host: Dr. Habela, your review starts with a very nice historical perspective, a historical overview of the development of genetic testing in epilepsy. Can you please help us understand how did we get where we are today? Christa Whelan Habela, MD, PhD: It has always been generally thought that epilepsy was a genetic disorder, even prior to any discovery of epilepsy genes. And the first gene associated with epilepsy was only discovered in 1997, and this was for the nicotinic acetylcholine receptor, and then from 1997 to 2007, only 10 more genes were discovered, and this was because we were using, very robust, but very slow and expensive Sanger Sequencing.  Early in the 2000s, the first untargeted genomic testing, came into clinical use, and this was the chromosomal microarray. This can be thought of as a very high resolution karyotype, and allowed us to look for deletions and duplications. But it really wasn't until the development of next generation sequencing which is a much faster and a much cheaper way of sequencing our DNA; that we really began to have an explosion in gene discovery. And so, beginning with next generation sequencing, this allowed us to develop whole exome sequencing, sequencing the exomes of our genes, as well as whole genome sequencing. And these two studies allowed us to identify hundreds of genes, up to a thousand genes from the years 2007 to present day. Host: Wow. So it looks like our baby steps took a long time, but we are going on leaps and bounds these days. And I imagine that we will be advancing much faster, now and into the future. Dr. Gerard, let's start with the basics to orient our audience. Could you please explain the difference between a gene, a chromosome, an exome in a way that helps our listeners follow the conversation on genetics? And if you could please link that to which tests correspond to which concept? Elizabeth E. Gerard, MD: So a gene can be thought of as a recipe for making a specific protein that's important to our body. And human genetic code contains about 20,000 recipes or 20,000 genes that make proteins. And so, as Dr. Habela was explaining, we had much faster understanding and ability to give back feedback on misspellings or typos in genes as we develop next generation sequencing. The Sanger sequencing she referred to, could really process one gene at a time. But now with next generation sequencing, we can process and understand the genetic code of multiple genes at a time. So while single gene testing is still rarely used for very specific phenotypes, like tuberous sclerosis or neurofibromatosis, more often, patients with epilepsy, with or without neurodevelopmental disorders may need a bunch of genes sequenced at the same time to increase the diagnostic yield. And one of the ways to do that are epilepsy gene panels or neurodevelopmental gene panels, which use next generation sequencing to look at usually on the order between 200 and 500 genes all at the same time and look for errors in the genetic code that may affect how that recipe works or how it may affect how you make proteins.  So that's one commonly done tests now which are gene panels. The genes or the recipes we have are organized into chromosomes. So humans have 23 pairs of chromosomes, and you can think about these as like sort of cookbooks, that contain the recipes. So another genetic variation that can happen that can contribute to disease and contribute to epilepsy, are sort of rearrangements within that chromosome book. So you can think about this as a missing page or half of a page missing. These are really deletions or duplications at the chromosomal level known as copy number variations. And these can include several genes or it can include just as small as part of one gene. And this stuff can be sometimes missed by gene panels or some next generation sequencing that's only focusing on certain parts of gene known as the exome, which we'll get to in a second. So the chromosomal microarray was one of the early tests used to make diagnosis in epilepsy and neurodevelopmental disorders. I think Dr. Habela will talk about the yield of this test, but this looks specifically for deletions or duplications at the chromosomal level. As I mentioned, there are 20,000 genes or recipes in our genetic code. And so we are moving very quickly away from these first two tests I mentioned to exomes. So whole exome sequencing, really sequences all those recipes, all the exonic parts of our recipes. We'll talk about the genetic code in our recipes, and can look at many, many, many genes at once. Even though they're looking at all of those genes in our genetic code; most exome analysis focuses on specific genes relevant to the patient's phenotype or the patient's symptoms. So this is really becoming one of the first tests that we're using in genetic testing for epilepsy and is thought by many to be one of the first two tests of choice. But there are still some things that exomes can miss. So they can miss those copy number variants in some cases if those are not at the levels that affect whole genes. Okay, they can also miss particular disorders like expansion repeat disorders, such as seen in CSTB related progressive myoclonic epilepsy. And then the other thing that's really important to recognize is that our exome with all those 20,000 genes, is really only 1 percent of all of our genetic code. So if you think about that recipe being made up of key components, like the ingredients that you need, that's really the exome. That set of instructions and those key factors that you need to make something or to make a recipe. But there's a lot of information on our genetic code in between the recipes or the small words within the recipe that actually tells us how to use it and how to make what we need to make. And that's the rest of

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  3. 2024. 11. 14.

    Epilepsy Currents - Episode 8 - "The Tell on Telehealth"

    Join Dr. Marawar in a conversation with Dr. Anup Patel, and Dr. John Stern, as they discuss the article, "The Tell on Telehealth". Click here to read the article. This podcast was sponsored by Marinus Pharmaceuticals. We'd also like to acknowledge Epilepsy Currents podcast editor Dr. Adriana Bermeo-Ovalle, and the team at Sage. In episode eight of the Epilepsy Currents Podcast, hosted by Dr. Rohit Marawar, the focus is on telehealth's role in epilepsy care. The episode features insights from Dr. Anup Patel and Dr. John Stern, who co-authored a review article on telehealth. They discuss the evolution of telehealth services, their importance for epilepsy patients, particularly in providing access to specialized care, and the challenges and future of telehealth in clinical practice. Brief Summary The podcast delves into how telehealth has become integral to epilepsy care, especially during the COVID-19 pandemic which accelerated its adoption and acceptance. The experts discuss the practicalities of telehealth, including the technological advancements that have made remote healthcare more accessible and effective. They also touch on the regulatory and reimbursement changes that have facilitated its broader use. The episode emphasizes telehealth's role in overcoming geographical barriers to specialized care, making it a critical service for those with mobility restrictions or who live far from epilepsy centers. Key Takeaways Historical Context and Evolution: Dr. Patel highlights that telehealth has been around for over two decades, but significant advances in technology and the necessity brought on by the COVID-19 pandemic have greatly expanded its use. The easing of restrictions around reimbursement during the pandemic also played a crucial role in its widespread adoption. Importance for Epilepsy Patients: Dr. Stern points out that beyond the convenience, telehealth is crucial for epilepsy patients due to the driving restrictions often associated with the condition. It allows patients to access specialized care regardless of geographical limitations, enhancing the quality of care they can receive. Challenges in Telehealth: Despite its benefits, telehealth presents challenges such as difficulties in performing complete neurological exams, managing neurostimulator devices and managing technological issues from both patient and provider sides. These challenges necessitate a hybrid model of care where telehealth complements, but does not replace, in-person visits. Patient Suitability: According to Dr. Patel, while telehealth is ideal for follow-up visits where a physical exam might not be critical, new patients or those needing detailed physical assessments might be better served by in-person visits. This distinction helps in optimizing care delivery based on patient needs. Future of Telehealth: Both experts agree that telehealth will continue to be a part of the healthcare landscape. Dr. Stern speculates that future enhancements may include more integrated remote patient monitoring and possibly satellite offices that provide some in-person support functions to complement telehealth visits, which could improve the quality of remote care. This episode effectively outlines the transformative impact of telehealth on epilepsy care, highlighting both its potential and limitations, and underscores the ongoing need to adapt and refine this mode of healthcare delivery to better serve patients' needs. Rohit Marawar, MD (Host): What if a doctor's visit no longer meant hours of travel or long waits in a clinic? For people with epilepsy, telehealth is redefining what access to care looks like. But is this shift here to stay? Today, we're unpacking the reality of telehealth and its growing role in epilepsy. Welcome to the Epilepsy Currents Podcast, an audio accompaniment to the Epilepsy Currents Journal, where we discuss the latest in epilepsy research and care. I'm your host, Rohit Marawar. Joining us today are Dr. Anup Patel, pediatric neurologist, and Dr. John Stern, adult neurologist, both leaders in epilepsy and co authors of the recently published Epilepsy Currents Review article, The Tell on Telehealth, which explores the evolution of telehealth, the challenges, and its impact on epilepsy patients. before we get started, a quick thanks to Mariners Pharmaceuticals, who is proud to sponsor this episode of Epilepsy Currents Podcast. welcome both. Thank you for joining us.  Let's get started, Dr. Patel. So I was intrigued to learn from your review article that telehealth isn't [00:01:00] actually a new concept and has been around for more than two decades. Could you give us a brief rundown of how telehealth has evolved over the years? And what led you to write this review article? Anup D. Patel, MD: that's a really great question. I think one of the things when we, started to look into this area as an opportunity that obviously became more available during the COVID 19 pandemic, we realized that others have been using telehealth and like you said for about 20 years, but I think the evolution really exists in the technology advances that we've had to make easier for us to actually do telehealth with a video in a safe but secure environment. I think the other big advantage obviously was the tipping point that occurred, and, during the COVID 19 pandemic. And what we recognize as an author group was that, there was not as much guidance as we needed or would want as it relates to telehealth visits, specifically The other thing is there's more than just a video [00:02:00] visit, which became obviously commonplace during the pandemic. The other advances, obviously, because of the pandemic was like the restrictions around reimbursement were reduced. And we'll talk more later in this episode about some of the licensure changes, but it was pretty open at that time, which allowed us to be able to access this technology to help improve or continue to maintain patient care. Rohit Marawar, MD (Host): Dr. Stern, why do you think telehealth has become such a crucial service for people with epilepsy? John M. Stern, MD: think an obvious part of the answer is the driving restrictions that people have who don't have seizure freedom and have epilepsy. think that's really only a small part of the importance because thankfully most people with epilepsy are seizure free. And the issue really becomes a matter of access because care for epilepsy has become much more sophisticated. It's required more specialized understanding. And Physicians who can provide that are not commonly distributed across the United States, so it's a matter of distance and access more than [00:03:00] drivability, in my mind, why it's so important, because you wouldn't want people, because of geography, to not have access to physicians with the expertise who can provide better care for them, whether or not they're seizure free. And this, in fact, maybe is no different for other conditions. beyond epilepsy. Whereas healthcare in general is shifting with this catalyst of COVID 19 to allowing people who are not geographically well situated for expertise to not be denied those opinions. Rohit Marawar, MD (Host): And again, Dr. Stern, when we compare outcomes for epilepsy patients who use telehealth versus those who have in person visits, what does the data show? Are there any major differences? John M. Stern, MD: have questions about the data because it comes down to the question of the outcomes and it comes down to, as well, how do you ascertain the outcome? people like telehealth because of the convenience, and that goes for both doctors and patients, but telehealth is not, perfect, and there are definitely problems that arise with telehealth care, which [00:04:00] we'll talk about, and so if the outcome is appreciation If we can't do this without availability and ability to communicate effectively, then telehealth can do very well. But, we need to be cognizant of telehealth being part of care delivery, and in my opinion, it's never going to replace in person visits because of the specific needs Benefits of being present with a person is two people. Rohit Marawar, MD (Host): Dr. Patel, kind of building on that, which type of patients do you think might be better suited for in person visits rather than a telehealth visit? Anup D. Patel, MD: Yeah, I think some of the research that we did and review of the literature showed that, you know, perhaps new patients would be better served, as being seen in person. I think that the other big thing is if there are motor and other, specific, um, Concerns around movement changes and for follow up patients, those would be better served in person. One of the challenges that we have with video telehealth is exactly picking up some of those [00:05:00] nuances, in the exam format. But otherwise, you know, there are a lot of advantages like Dr. Stern mentioned to the telehealth visit? and most of the epilepsy follow ups, you know, obviously the exam isn't going to be as helpful. So in those situations, telehealth might be a little bit more ideal, but. Beyond that, you know, like Dr. Stern said, the other area that really favors inpatient is if you have a neurostimulation device, to be able to interrogate or evaluate that device, it really needs to obviously be in person in this present day. Now that may change with some of the technological advances on the horizon, but as of now, those patients should be seen at least once a year, if not more, inpatient for that device interrogation. Rohit Marawar, MD (Host): Makes sense. Dr. Patel, your article includes a comprehensive table on how to conduct a successful telehealth visit. Could you share some key considerations and maybe a few tips from your personal experience that have made your telehealth appointments run smoother? Anup D. Patel, MD: Yeah, and I think [00:06:00] we've learned a lot in this area. I think that the assumptions we had m

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  4. 2024. 08. 20.

    Epilepsy Currents - Episode 7 - "It's Current: NAEC Provides Us With the Recipe to Build a Better Epilepsy Center"

    Join Dr. Bermeo in a conversation with Dr. Susan Arnold, and Dr. Fred Lado, as they discuss the article, "It's Current: NAEC Provides Us With the Recipe to Build a Better Epilepsy Center". Click here to read the article. This podcast was sponsored by the National Association of Epilepsy Centers (NAEC). 2023 Guidelines for Specialized Epilepsy Centers We'd also like to acknowledge Epilepsy Currents podcast editor Dr. Adriana Bermeo-Ovalle, and contributing editor Dr. Rohit Marawar, and the team at Sage.  In episode 7 of the Epilepsy Currents podcast, the discussion focuses on the 2023 Guidelines for Specialized Epilepsy Centers, published by the National Association of Epilepsy Centers (NAEC). Hosted by Dr. Adriana Bermeo, the episode features insights from Dr. Susan Arnold, the senior author of the executive summary of the report, and Dr. Fred Lado, president of the NAEC and the first author of the guidelines. The guidelines aim to set comprehensive standards for epilepsy care, particularly addressing the needs of patients with drug-resistant epilepsy. Brief Summary The 2023 NAEC guidelines for epilepsy care are designed to elevate the standards of care provided at specialized epilepsy centers. These guidelines distinguish between best practices for patient care and accreditation standards, the latter being what centers must meet to receive NAEC accreditation. Developed through an "evidence-informed consensus" process, these guidelines include contributions from a diverse panel, including neurologists, nurses, EEG technologists, social workers, neuropsychologists, patients, and caregivers. This inclusive approach ensures that the guidelines address comprehensive needs across the spectrum of epilepsy care. Key Takeaways Guideline and Accreditation Distinction: Dr. Lado clarified the difference between the NAEC's guidelines and its accreditation process. The guidelines represent consensus on best practices in epilepsy care, while accreditation standards are specific criteria that centers must meet to demonstrate adherence to these practices. This distinction helps centers focus on gradual implementation of the guidelines without immediate pressure for compliance. Inclusive Development Process: Dr. Arnold emphasized that the guidelines were developed through an evidence-informed consensus, incorporating opinions from a broad array of stakeholders, including those directly affected by epilepsy. This method helps ensure that the guidelines are comprehensive and address practical aspects of patient care. Focus on Comprehensive Care: The guidelines have expanded to cover not only inpatient and surgical care but also comprehensive outpatient services, reflecting the realities of where most epilepsy care occurs. This shift acknowledges the importance of accessibility, communication, and specialized services for various patient groups. Resource Considerations: Recognizing the resource-intensive nature of comprehensive epilepsy care, the guidelines provide a framework for centers to gradually adapt to higher standards without abrupt changes. This gradual implementation is intended to ease the burden on centers, allowing them time to secure necessary resources. Future Directions and Improvements: The guidelines are seen as a living document, with the NAEC planning more frequent updates to keep pace with advancements in epilepsy treatment and care. This adaptive approach aims to ensure that the guidelines remain relevant and practical for implementing the latest best practices in epilepsy care.   Transcript    Adrianna Bermeo-Ovalle, MD (Host): The main purpose that brings our community together is our desire and resolve to offer people living with epilepsy the best alternatives of diagnosis and treatment; the ones that will empower them to live their best possible life. But what does that mean in practical terms? How do we put that intention into clinical practice? The National Association of Epilepsy Centers, NAEC, has taken a careful look at this question. We are delighted to have the opportunity to discuss together the 2023 Guidelines for Specialized Epilepsy Centers that will inform epilepsy care in the present and the future. Welcome to Episode 7 of Epilepsy Currents Podcast. I am your host, Adriana Bermeo. I am the Senior Podcast Editor for Epilepsy Currents, the official journal of the American Epilepsy Society. Let me first welcome Dr. Susan Arnold. Dr. Arnold is Adjunct Professor of Pediatric Neurology at Yale University School of Medicine. She's the Senior Author of the Executive Summary of the Report of the National Association of Epilepsy Centers, entitled Guidelines for Specialized Epilepsy Centers, which was published by the Green Journal Neurology in February of 2024. Dr. Arnold, thank you very much for joining us today. Susan T Arnold, MD: I'm very happy to be here. Host: It is also my pleasure to welcome Dr. Fred Lado. Dr. Lado is the president of the NAEC and professor of neurology at the Zucker School of Medicine in Hofstra University in Long Island, New York. Dr. Lado is the first author of the guidelines, which you can find linked to the Epilepsy Current site and at the NAEC home site. Dr. Lado, thank you for being with us today. Fred A. Lado, MD, PhD: Thank you, Adriana, for the opportunity to speak with you. Host: Great. For our listeners and our readers of Epilepsy Currents, you can also find an It's Currents commentary authored by Dr. Katherine Nichols and published in the May 2024 issue of Epilepsy Currents. So let's get this conversation started. Dr. Lado, I will start with you. Could you please explain to our listeners the role of the National Association of Epilepsy Centers in setting national standards for epilepsy care, especially for those dealing with drug resistant epilepsy? Fred A. Lado, MD, PhD: So the NAEC was founded in 1987, and since almost the beginning, has published quality standards around the functioning and the care given in epilepsy centers. These standards have been updated approximately every 10 years. And these standards are different from the accreditation program that the NAEC runs. That accreditation program began in 2016. The guidelines have been the basis for developing accreditation standards, but for accreditation standards, centers have to provide evidence that they're meeting the guidelines. Guidelines are really focused on what is best practices. What is the best level of care that patients should be receiving? Accreditation standards are focused on, are centers implementing these guidelines? Are they actually providing these services? Many of the recommendations that you'll find in these new guidelines are already present in prior versions of the NAEC guidelines and in the accreditation program, but many of the guidelines in the current version are new and sort of stretch the boundaries of areas that the NAEC is addressing as part of comprehensive epilepsy care. We recognize that in sort of moving the goalpost somewhat, that in expanding the scope of guidelines, that epilepsy centers need to have adequate resources to implement. And so the process of incorporating these guidelines into accreditation is one that will unfold over the coming years, not all at once. Host: Thank you very much for that answer. Can you just once more clarify what is the difference, how are the guidelines different from the accreditation process for the people in the epilepsy centers who may get a little bit nervous about all the new recommendations that come in the guidelines? What is the urgency for them to implement all of these recommendations into the care they provide for their patients? Fred A. Lado, MD, PhD: Yes, this is a topic of great sensitivity in epilepsy centers. The guidelines, as we'll discuss are really the product of a consensus across sub specialists, patients, administrators, EEG techs, certainly epileptologists, about what makes a good epilepsy care, what makes a successful epilepsy center in taking care of patients. But the guidelines are sort of a recommendation of best practices. They are not accreditation standards. Accreditation standards are what the NAEC uses to judge whether a program is meeting the requirements for NAEC accreditation, and that might involve showing reports, might involve doing a certain volume of particular cases or surgeries, it has different specific requirements. The accreditation standards that the NAEC establishes and changes and updates from year to year, are informed by these guidelines. But the guidelines are a statement of what is considered best practice. The accreditation standards are a statement of what centers have to do to become accredited. Host: Thank you very much for clarifying that for our listeners and our readers. Dr. Arnold, we understand that these guidelines were developed through a process that is called evidence informed consensus. Can you please elaborate on the methodology and how does it influence the recommendations provided? And if you could, how are they different from the prior guidelines published by the NAEC? Susan T Arnold, MD: So, the idea when you're writing guidelines is really to have an evidence based process where you survey the literature, collect information, grade the evidence that you collect, and then write your recommendations based on that evidence with the level of the evidence supporting your guideline. And that works very well for clinical treatment guidelines, where you can search the literature and find studies that compare, for example, one intervention to another. Unfortunately, for an operational guideline, such as the one we were writing for epilepsy centers, the literature doesn't have a lot of information. And where we do have evidence, it's often not of very high quality and it has gaps. And so in that circumstance, you go to expert opinion. And so what we did is follow an evidence informed process; where we su

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  5. 2024. 06. 05.

    Epilepsy Currents - Episode 6 - " Hiding in Plain Sight—Neighborhood Versus Individual Determinants of Psychological Outcomes in Patients With Epilepsy"

    Join Dr. Bermeo in a conversation with Dr. Jarrod E. Dalton, Dr. Bruce Hermann, and Dr. Samuel Terman, as they discuss the article, "Hiding in Plain Sight—Neighborhood Versus Individual Determinants of Psychological Outcomes in Patients With Epilepsy ". Click here to read the article. This podcast was sponsored by the American Epilepsy Society through a grant from the Centers for Disease Control (CDC). These activities are supported by the Centers for Disease Control (CDC) and Prevention of the U.S. Department of Health and Human Services (HHS) as part of a financial assistance award totaling $1,500,000 with 100% funded by CDC/HHS. The contents are those of the author(s) and do not necessarily represent the official views of, nor are they an endorsement, by CDC/HHS, or the U.S. Government. We'd also like to acknowledge contributing editor Dr. Rohit Marawar, and the team at Sage. Summary The podcast features a discussion on how environmental conditions, specifically neighborhood deprivation, affect cognitive outcomes and mood in individuals with pharmacoresistant temporal lobe epilepsy. Dr. Hermann & Dr. Dalton's study found that patients living in more deprived areas exhibited significantly lower cognitive performance and increased levels of anxiety and depression compared to those in less deprived areas. Dr. Terman's commentary critically assesses these findings, stressing the importance of considering environmental factors alongside biological ones in understanding and treating epilepsy.   Key Takeaways Impact of Neighborhood Deprivation: The study highlighted a strong correlation between increased neighborhood deprivation and poorer cognitive outcomes as well as higher levels of anxiety and depression among epilepsy patients. This suggests that external environmental factors play a crucial role in the health outcomes of individuals with temporal lobe epilepsy. Role of Area Deprivation Index (ADI): The ADI is utilized to quantify neighborhood deprivation, encompassing factors like income, education, and housing conditions. It provided a robust framework for analyzing the socioeconomic conditions impacting patient outcomes, underlining the relevance of broader social determinants in health disparities. Implications for Clinical Practice: These findings underscore the need for clinicians to consider the socioeconomic environment of patients when diagnosing and treating epilepsy. Addressing environmental factors could enhance therapeutic outcomes and improve quality of life for patients. Study Limitations and Future Research: Dr. Terman noted limitations such as the cross-sectional nature of the study, which complicates the ability to infer causation. He advocates for longitudinal studies to better understand how and when neighborhood factors impact patient health, potentially leading to more targeted interventions. Potential for Broader Implications: The discussion extends beyond epilepsy, suggesting that similar environmental influences could be significant across other neurological and psychiatric conditions. Future research might explore how modifications in social policy and urban planning could mitigate these health disparities. [00:00:00] Adriana Bermeo (Host): It is well known that individuals living with epilepsy are at risk of experiencing cognitive decline and psychiatric comorbidities. But did you know that the individual's home address plays a significant role in the cognitive and psychiatric outcomes of people living with temporal lobe epilepsy? [00:00:18] Welcome to episode number six of Epilepsy Currents podcast. Today, we will be talking about the role of environmental factors on cognition and mood of patients with temporal lobe epilepsy. I am your host, Adriana Bermeo. I am the Senior Podcast Editor for Epilepsy Currents, the official journal of the American Epilepsy Society. [00:00:40] I want to first welcome contributing editor, Dr. Samuel Terman, who wrote the commentary, Hiding in Plain Sight--Neighborhood vs. Individual Determinants of Psychological Outcomes in Patients with Epilepsy. This commentary was published on the March 2024 issue of Epilepsy Currents. [00:01:00] Dr. Terman is an Assistant Professor at the University of Michigan. Dr. Terman, welcome to Epilepsy Currents Podcast. [00:01:07] Samuel W. Terman, MD, MS: Thanks so much. Happy to be here. [00:01:09] Host: It is also my pleasure to welcome Dr. Bruce Hermann, who is the Senior Author of the work that inspired this commentary, titled Association of Neighborhood Deprivation with Cognitive and Mood Outcomes in Adults with Pharmacoresistant Temporal Lobe Epilepsy. Their paper was published in Neurology in June 2023. Dr. Hermann is Emeritus professor of Neuropsychology at the University of Wisconsin School of Medicine and Public Health. Welcome, Dr. Hermann. Thank you for being with us. [00:01:39] Bruce Hermann: Thank you, and good afternoon. [00:01:41] Host: We are also joined by Dr. Jarrod Dalton, who is co-author on the original paper. Dr. Dalton is an Associate Professor and the Director of the Center for Population Health Research at the Cleveland Clinic's Lerner Research Institute. Dr. Dalton, thank you for being with us today. [00:01:58] Jerrod Dalton, PhD: And thank you. [00:01:59] Host: While [00:02:00] neurologists and epileptologists are familiar with the effects of the biological characteristics of the lesions causing epilepsy, the neurophysiological findings of the treatments we use in the clinic, we are much less likely to consider their patient's immediate living environment, their access to healthy foods, exposure to violence, or their access to transportation as potential modifiable variables directly affecting someone's epilepsy outcomes. [00:02:28] Dr. Hermann. Would you mind sharing with us a snapshot of the findings from your study in a way our listeners can grasp? [00:02:35] Bruce Hermann: Dr. Busch and I have been collaborators for quite some time, and she was able to compile an amazing cohort of 800 patients with pharmacoresistant temporal lobe epilepsy who underwent neuropsychological assessment as part of their inpatient evaluations at the Cleveland Clinic. And then, she and Dr. Dalton extracted home addresses from the EMR and binned the patients into ADI quintiles. [00:03:00] And from the neuropsychological battery that was quite extensive, as is commonly the case in preoperative evaluations, the data was reduced to seven mean cognitive domains, things such as intelligence, language, visual perception, verbal and visual memory, executive function, processing speed. And then, secondarily classified all the patients into four cognitive phenotypes that range from intact, essentially unaffected, to generalized cognitive impairment. [00:03:32] So, the core finding and most important finding was that examination of the relationship of the Area Deprivation index was closely aligned with the cognitive scores. So as deprivation increased, cognitive scores went down. This was seen across seven of the six cognitive domain scores, and greater deprivation was associated with the more abnormal cognitive phenotype. And increasing neighborhood deprivation was also associated with [00:04:00] greater anxiety and depression. So, it really was quite a signal that we were able to observe. And as Dr. Terman pointed out in his commentary, you can just take a look at IQ. Quintile 1, the least deprived group, had a mean IQ score of 100, which is dead average. And the most deprived quintile, Quintile 5, their mean IQ was 86, which is a full standard deviation below average. So, very reliable and fairly strong signal throughout these results. [00:04:28] Host: Yeah. Really striking findings, which seem to point out that the deprivation that patients are exposed is almost as important as the biology of the condition. And I'm sure we will discuss that in length later. Dr. Dalton, the concept of the Area Deprivation Index, or ADI, plays a central role in the study. Can you please help us understand what does this measure? How do these quintiles work? And how is this measurement different from other measurements of socioeconomic status? [00:04:59] Jerrod Dalton, PhD: [00:05:00] Sure. Yeah, the Area Deprivation Index is a tool that we use in our research in a lot of settings. We work with clinical specialties across Cleveland Clinic and use this as one tool for understanding place-based health disparities. Essentially, the Area Deprivation Index, it's a latent variable model or a factor model that produces an index that captures correlation among 17 neighborhood-level characteristics. The ADI was established at the National Cancer Institute in 2003 by a demographer and sociologist named Gopal Singh. It was designed as scale of neighborhood socioeconomic position as opposed to socioeconomic status, which I can distinguish a little bit between the two. And it incorporates aspects of social organization, income, housing, economic inequality, and opportunity structure. [00:05:56] So, the indicators that comprise the ADI [00:06:00] are varied, but they all speak to overall socioeconomic characteristics. So, it'll include measures of education, proportions by level of education. It includes measures of income, such as median family income, income disparities. It includes measures of housing and housing affordability, median home value, median rent, monthly mortgage amounts, and percent of households [00:06:27] It also includes economic and employment measures such as labor force participation rates and poverty rates, family structure measures such as the percent of single-parent households among those with somebody less than 18 years of age, and a series of resources such as motor vehicle ownership, telephone ownership, and whether or not households have plumbing. [00:06:50] Host: And those variables are related to the neighborhood where the patient is living rather than to the individual patient. I

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  6. 2024. 03. 29.

    Epilepsy Currents - Episode 5 - "More Than Meets the Eye: Human Versus Computer in the Neuroimaging of Temporal Lobe Epilepsy"

    Join Dr. Bermeo in a conversation with Dr. Ezequiel Gleichgerrcht, Dr. Erik Kaestner, and Dr. Peter Widdess Walsh, as they discuss the article, "More Than Meets the Eye: Human Versus Computer in the Neuroimaging of Temporal Lobe Epilepsy". Click here to read the article. This podcast was sponsored by the American Epilepsy Society. We'd also like to acknowledge contributing editor Dr. Rohit Marawar, and the team at Sage Publishing.   Summary This fantastic Epilepsy Currents podcast episode delves into a groundbreaking study on the application of artificial intelligence (AI) in differentiating temporal lobe epilepsy from Alzheimer's disease and healthy controls using MRI-based deep learning. The study, co-authored by Dr. Ezequiel Gleichgerrcht and Dr. Erik Kaestner, demonstrated AI's potential to significantly improve the accuracy of neuroimaging analysis in epilepsy. The commentary by Dr. Peter Widdess-Walsh provided a critical examination of these findings, highlighting the practical implications for clinical practice and the limitations of current methodologies. The discussion framed AI not only as a tool for enhancing diagnostic accuracy but also as a means to uncover subtle neurobiological differences between diseases, potentially leading to more personalized treatment approaches.   Key Takeaways High Diagnostic Accuracy with AI: The study highlighted showed that AI, specifically convolutional neural networks (CNNs), could differentiate between temporal lobe epilepsy, Alzheimer's disease, and healthy controls with high accuracy. This demonstrates AI's capability to identify nuanced patterns in neuroimaging that may not be visible to the human eye. AI Identifies Subtle Neurological Differences: The inclusion of Alzheimer's disease as a comparative group in the study was strategic to determine if the AI was recognizing temporal lobe epilepsy based on hippocampal atrophy alone or other disease-specific patterns. The findings suggest that AI can discern epilepsy-related patterns beyond the typical markers, indicating a profound potential for AI in understanding complex neurological conditions. Impact on Clinical Practice: Dr. Widdess-Walsh's commentary underscores the importance of these findings for clinical practice. AI's superior detection rate compared to human analysis (90% versus 47%) suggests that AI could significantly augment clinicians' ability to diagnose temporal lobe epilepsy, potentially leading to earlier and more accurate interventions. Limitations and Ethical Considerations: Despite AI's impressive capabilities, the podcast discussion acknowledges limitations, including the current inability of AI systems to interpret scans holistically, consider clinical context, or replace human decision-making. These factors highlight the need for AI to be used as an adjunct tool in clinical practice, enhancing rather than replacing the expertise of healthcare professionals. Future Directions and Challenges: The episode concludes with reflections on the broader implications of AI in neurology, from predicting surgery outcomes to possibly revolutionizing epilepsy care. However, challenges such as external validation, regulatory approval, and integration into clinical workflows must be addressed to fully realize AI's potential in epilepsy diagnosis and treatment.   Transcript Adriana Bermeo, MD (Host): Hello and welcome to episode five of Epilepsy Currents podcast. Today, we will be talking about the use of artificial intelligence and machine learning in the study of temporal lobe epilepsy. I am your host, Adriana Bermeo. I am the senior podcast editor for Epilepsy Currents, the official journal of the American Epilepsy Society. Today, I am joined by a team of experts in this very exciting neurodiagnostic arena. I want to first welcome contributing editor, Dr. Peter Widdess-Walsh, who wrote the commentary "More Than Meets the Eye: Human vs. Computer Neuroimaging of Temporal Lobe Epilepsy." This commentary was published on December 2023 issue of Epilepsy Currents. Dr. Widdess-Walsh is a consultant neurologist and Clinical Associate Professor at Beaumont Hospital in Dublin, Ireland. Peter, welcome to Epilepsy Currents podcast. podcast. Peter Widdess-Walsh, MD: Thank you very much, Adriana. I'm delighted to be here. Host: Thank you for being here. It is also my pleasure to welcome Dr. Ezequiel Zeke Gleichgerrcht, who authored the work that inspired this commentary titled, "MRI Based Deep Learning Can Discriminate Between Temporal Lobe Epilepsy, Alzheimer's Disease, and Healthy Controls. Their paper was published in Nature Communications Medicine in 2023. Dr. Gleichgerrcht is an Assistant Professor of Neurology at Emory University. Zeke, welcome. Ezequiel Gleichgerrcht, MD: Thank you. Thanks for having me. Host: We are also joined by Dr. Erik Kaestner, co-author on the original paper and lead author on other related publications addressing the use of artificial intelligence in epilepsy. Dr. Kaestner is a postdoctoral scholar at University of California, San Diego. Erik, thanks for being with us today. Erik Kaestner, PhD: Thank you. Excited for the conversation. Host: Very good. I can tell you that artificial intelligence is one of the most requested topics when we ask our listeners and the epilepsy community. The challenges and opportunities presented by the use of AI in almost every aspect of our daily life, but particularly in healthcare, are intriguing, exciting, and potentially concerning to some. But before we start discussing AI, Peter, can you share with our listeners what is the added value of expanded neuroradiology in the care of patients with epilepsy? Peter Widdess-Walsh, MD: Thanks, Adriana. And thank you for highlighting this very interesting and topical article for the podcast. And many thanks to Dr. Gleichgerrcht and Dr. Kaestner for being here with us. We know that MRI is a key tool in finding the underlying cause of focal epilepsy. However, up to 30% of MRIs are non-lesional. That is, there is no visible lesion responsible for the patient's epilepsy. We can sometimes lower this non-lesional percentage by using additional MRI techniques such as volumetry or various additional sequences or higher strength magnets. But these are not universally available or have limitations, so there's a gap there. We know that there is a focal epileptogenic network, but we cannot see it. And it is partly due to limitations of MRI technology, which are improving all the time, but it's partly due to limitations of what we can see visually with the human eye. There are also human error rates in analyzing MRI, even with skilled radiologists known as perceptual errors. A shrunken, bright hippocampus is easier to see than subtle alterations in grey matter volumes. Particularly in surgically remediable epilepsies, finding a lesion or visualizing the epileptic network can make a huge difference in a better patient outcome after surgery. And even in non-surgical patients, it's very reassuring to have an imaging correlate of the epilepsy that you know is clinically present. I'm not an AI expert and I wrote the commentary from the perspective of an epileptologist in clinical practice like many of our listeners. So, it was fascinating to learn more about AI and how it might fit into our daily practice in this area. The authors used the term computer vision in this article, and I'm excited to learn more about how computer vision can help us in the diagnosis of epilepsy. Host: Thank you very much. We are certainly excited to see how we can advance our field further than what we are practicing at the moment. Zeke, could you paint the picture as for how is AI revolutionizing the field of radiology and particularly when it comes to neuroimaging analysis? Ezequiel Gleichgerrcht, MD: Yeah, absolutely. And I think we start acknowledging that AI is becoming this true transformative force in medicine. Like you said, neuroimaging is by no means the exception. So for instance, if we think about AI and how it gives us frameworks to analyze huge amounts of imaging data, the pace and precision with which it can achieve it is unattainable by humans alone, right? Humans not using this computer vision that Peter was mentioning. So, let's talk about neuroimaging specifically. AI algorithms can sift through MRI, CT scans, and, almost do a first pass at detecting abnormalities from brain tumors, there's applications for aneurysms, areas affected by stroke, you name it. Of course, our interest is in epilepsy, but we know how crucial early and accurate detection of some of these findings can be. So, you know, when trying to answer this question, how is it revolutionizing the field of radiology? I think it's really about how the accurate detection of these findings can be instrumental in patient care. So, AI applied to neuroimaging can help us mostly scale detection of brain diseases and have tremendous impact on outcomes. But it's not just about detection of disease, right? AI now can support decisions about care tailoring or personalization of patient care, because if you can combine neuroimaging and health data, now you can offer insights that lead to more tailored strategies. For example, in other studies, we have shown that using AI, we can predict who becomes seizure free after epilepsy surgery based exclusively on preoperative imaging. And we found accuracies that are 30% points higher than what humans achieve just based on their combination of health data alone. You know, when I think about the revolution of AI, it's also paving the way for prediction or predictive analysis, things like forecasting disease progression or identifying when seizures will happen, for example, for a given patient. So, it's certainly a very exciting time for AI and neuroimaging and epilepsy. Host: Wow, that's a lot of changes expected for the future in the way we practice. Erik, I want to bring it to you for those of us who

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  7. 2023. 10. 23.

    Epilepsy Currents - Episode 4 - "Dobbs vs Jackson - Epilepsy Reproductive Health and Abortion"

    Join Dr. Bermeo in a conversation with Dr. Page Pennell and Dr. Alison Pack as they discuss the article, "Dobbs Versus Jackson: Epilepsy, Reproductive Health, and Abortion". Click here to read the article. This podcast was sponsored by the American Epilepsy Society. We'd also like to acknowledge contributing editor Dr. Rohit Marawar, and the team at Sage Publishing. Summary: In this episode of the Epilepsy Currents podcast, Dr. Adriana Bermeo discusses the Supreme Court's decision on Dobbs v Jackson and its implications for people living with epilepsy. She is joined by Dr. Allison Pack, a professor of neurology at Columbia University, and Dr. Page Pennell, the chair of the Department of Neurology at the University of Pittsburgh School of Medicine. They discuss the key points and historical significance of the Roe v. Wade and Dobbs v Jackson rulings, the current state-by-state variation of abortion access in the United States, and the impact on women and people of childbearing age living with epilepsy. They also address the importance of contraception, the risks of anti-seizure medications during pregnancy, and the need for evidence-based care and advocacy for patients. Resources such as the Guttmacher Institute and the National Abortion Federation Hotline are mentioned for further information and support.   5 Key Takeaways: 1. The Supreme Court's decision on Dobbs v Jackson has significant consequences for persons living with epilepsy and their access to abortion. 2. The current state-by-state variation of abortion access in the United States is complex and can range from very restrictive to most protective. 3. Planned pregnancies are crucial for individuals with epilepsy to optimize outcomes for both the individual and the developing fetus. 4. Effective contraception is important for individuals with epilepsy, and options such as long-acting reversible contraception (IUDs) and birth control pills should be considered. 5. Neurologists and epilepsy specialists should advocate for their patients' rights and women's rights, ensuring that medical decisions are made by qualified practitioners based on evidence and with respect for the individual patient. Resources such as the Guttmacher Institute and the National Abortion Federation Hotline can provide information and support.     Transcript Dr. Adriana Bermeo (00:05): Hello and welcome to episode four of Epilepsy Currents podcast. I am your host, Adriana Bermeo. I am the senior podcast editor for Epilepsy Currents, the official journal of the American Epilepsy Society. It is my pleasure to welcome today's guest to talk about the Supreme Court's decision on Dobbs v Jackson and its consequences for persons living with epilepsy. We have two very special guests to help us understand the implications of this ruling on reproductive health and access to abortion for people living with epilepsy of childbearing potential. First, I want to welcome Dr. Pack, senior author of a commentary titled Dobbs versus Jackson Epilepsy Reproductive Health and Abortion, published online first in the May, 2023 issue of Epilepsy Currents. Dr. Pack is a professor of neurology at Columbia University. She's the Chief division of Epilepsy and sleep at New York Presbyterian, Columbia University Medical Center. I also want to especially welcome Dr. Page Pennell, who's the Henry B. Hickman Professor of Neurology and chair of the Department of Neurology at the University of Pittsburgh School of Medicine. Dr. Pennell is a global expert on the management of pregnancy-related issues in epilepsy, and she's also a past president of the American Epilepsy Society. Dr. Pack, let me start with you. Most of our listeners are familiar with Roe versus Wade and Dobbs versus Jackson Supreme Court rulings, but could you give us a quick refresher on the key points and historical significance of these two landmark cases? Dr. Allison Pack (01:43): Thank you very much, Adriana, and it's a pleasure to be here today and I want to thank the American Epilepsy Society for supporting this discussion as we go through our discussion today. Today we will be referring to persons with epilepsy of childbearing potential. Please recognize that we are aware that not all individuals who seek pregnancy or become pregnant identify as a woman. So I'm going to go through right now the court rulings ruling Roe v. Wade was enacted in 1973. In this ruling, the court ruled that the Constitution of the United States generally protected a right to abortion. This ruling was reaffirmed in 1992 in the ruling Planned Parenthood of Southeastern Pennsylvania versus Casey. Dobbs v Jackson was enacted on June 24th, 2022. With this ruling, the Constitution does not confer a right to abortion. Essentially, Roe v. Wade and Planned Parenthood of Southeastern Pennsylvania versus Casey were overturned. The authority to regulate abortion went back to the state and the constitutional right to abortion was eliminated. Dr. Adriana Bermeo (03:08): Thanks, Dr. Pack, you were mentioning how things went back to the state, and as we know, the legal landscape of these rulings then are evolving. Acknowledging this is a moving target, could you please help us understand the current state-by-state variation of abortion access in the United States, and what does this mean for the physicians practicing in the different states? Dr. Allison Pack (03:37): Well, I have to say understanding the state-by-state variations is quite complex. I would draw all of your attention to the Guttmacher Institute, and there's a very good website whereby you can see the map of the United States and the outline of the various regulations or the various degrees of restriction. And these vary from most restrictive occurring in over 15 states whereby abortion is banned at 12 weeks and later. There are very restrictive, which bans abortion at 12 weeks and later. Some restrictions starting at the third trimester. Protective, it's banned at fetal viability between 24 and 26 weeks, and very protective whereby it's banned at fetal viability. And then there's some other regulations that give more protections than those states that are protective and then most protective whereby there is no restriction based on gestational age. As I mentioned earlier, the most restrictive; this includes, for example, Kentucky, Texas, very restrictive, North Carolina, Georgia, some restrictions, Virginia protective, Illinois, very protective New York, and then most protective, there's only one, and that is the state of Oregon. So it is important to understand that there are varying degrees of restrictions across the United States in these different categories. And as I mentioned earlier, I would draw your attention to the website from the Guttmacher Institute, which really is very helpful for you to understand what the restrictions are or not in the state that you live. Dr. Adriana Bermeo (05:29): Thank you very much, Dr. Pennell. Can I turn it to you? Can you please help us understand how these rulings affect particularly women and person of childbearing age or childbearing potential living with epilepsy? Dr. Page Pennel (05:42): Yes. Thank you also for inviting me for this very important podcast and to sit alongside Dr. Pack who is such an expert in this area. So unplanned pregnancies in the general population are known to have a higher complication rate, but especially in persons with epilepsy, it's incredibly important to have a Planned Pregnancy and for the woman to have the best seizure control possible for her with the medication regimen and vitamin regimen that will provide the opportunity for the safety of the developing fetus. Pregnancy also carries a risk to women directly and with persons with epilepsy there are reports of elevated maternal mortality. Studies in the UK have actually shown that the elevated rates of death in persons with epilepsy are due to SUDEP or sudden unexpected death in epilepsy. So if a woman with epilepsy goes into a pregnancy unplanned and also with a high seizure burden, the chances that pregnancy will be unsafe for her and her developing fetus are much higher. And if she doesn't have the opportunity to make a decision with her clinician about what to do after that time, it can be particularly devastating. Dr. Adriana Bermeo (07:05): Dr. Pack, your commentary in Epilepsy Currents really makes the point that neurologists ,epileptologists and the organizations who represent their interests should care and take action in protecting patients' rights and women's rights. Can you please expand on this idea? Why should neurologists and epilepsy specialists care? Dr. Allison Pack (07:29): Well as individuals or practitioners who take care of persons with epilepsy of childbearing potential, we want to provide the optimal environment both for seizure control and pregnancy outcomes for the individual as well as the developing fetus. It is as the American Epilepsy Society has stated, critically important that medical decisions are made by qualified practitioners and that this be done based on evidence with respect for the individual patient. Therefore, the decisions made for the outcome or the health of the individual should be up to the practitioner and patient themselves or the person with epilepsy. Many of our anti-seizure medications may increase the risk of unplanned pregnancy. This is important. It's important that the individual has an unplanned pregnancy and are in a state whereby there are extreme restrictions. Again, as I mentioned, the decision should be left up to the provider and the person with epilepsy. As well, many anti-seizure medications, notably valproic acid, can increase the risk of adverse or negative pregnancy outcomes. As practitioners, we need to be aware of and advocate for the patients that should this occur to these individuals, that they do have options available to them to optimize their health as well

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  8. 2023. 06. 20.

    Epilepsy Currents – Episode 3 "Keto Is Not Just for Kids: A Randomized Trial of a Modified Atkins Diet for Adolescents and Adults With Anti-Seizure Medication Resistant Epilepsy"

    Join Dr. Bermeo in a conversation with Dr. Mackenzie Cervenka and Dr. Manjari Tripathi as they discuss the article, " Keto is Not Just for Kids: A Randomized Trial of a Modified Atkins Diet for Adolescents and Adults With Anti-Seizure Medication Resistant Epilepsy ". Click here to read the article. This podcast was sponsored by the American Epilepsy Society. We'd also like to acknowledge contributing editor Dr. Rohit Marawar, and the team at Sage Publishing.   Five Key Takeaways:   Effectiveness of Modified Atkins Diet (MAD): The research conducted by Dr. Manjari Tripathi found that 26% of the people who supplemented their drug therapy with the MAD experienced a more than 50% reduction in seizure frequency compared to only 2.5% of people who used only drug therapy. Importantly, some patients even became seizure-free. Improved Quality of Life: Along with a significant decrease in seizures, patients following the MAD also reported improved quality of life and behavior. Difference in Adherence Between Adolescents and Adults: The study found that adults were more likely to adhere to the diet than adolescents, possibly due to a combination of food preferences and possible differences in gut microbiota. Potential Long-Term Effects of Ketogenic Diets: While ketogenic diets can be effective in managing epilepsy, there are potential long-term side effects to consider, such as vitamin and mineral deficiencies, bone loss, risk of nephrolithiasis (kidney stones), and hyperlipidemia (high levels of lipids in the blood), which may lead to cardiovascular and cerebrovascular diseases. Approach to Weaning off the Diet: Dr. Mackenzie Cervenka suggests that weaning off the diet should be considered in a similar manner to removing anti-seizure medication. The decision should be made considering the side effects and the overall burden of the therapy on the patient. Abrupt discontinuation of the diet can result in an increase in seizures, hence the diet should be gradually reduced. Dr. Adriana Bermeo (00:06): Hello, and welcome to episode three of Epilepsy Currents podcast. I am your host, Adriana Bermeo. I am the senior podcast editor for Epilepsy Currents, the official journal of the American Epilepsy Society. It is my pleasure to welcome today's guest to talk about the use of ketogenic diets in the treatment of refractory epilepsy in adolescents and adults. First, I want to welcome our contributing editor for epilepsy current, Dr. Mackenzie Cervenka, who wrote a commentary titled "Keto Is Not Just For Kids: a randomized trial of a modified Atkins diets for adolescents and adults with anti-seizure medication resistant epilepsy". This was published online first in the March, 2023 issue of Epilepsy Currents. Dr. Cervenka is Professor of Neurology at John Hopkins School of Medicine. She's the medical director of the Adult Epilepsy Diet Center and the Adult Epilepsy Monitoring Unit. She developed the John Hopkins Adult Epilepsy Dietary Center in 2010 and has treated nearly 450 adults with epilepsy using ketogenic diet. Dr.Cervenka, welcome to Epilepsy Currents podcast. Dr. Mackenzie Cervenka (01:16): Thank you so much Dr. Bermeo for inviting me as a guest today at the Epilepsy Currents Podcast. Dr. Adriana Bermeo (01:22): It's a pleasure to have you. I also want to specially welcome Dr. Manjari Tripathi, who is the senior author of the publication that inspired this commentary titled "Safety, efficacy, and Tolerability of Modified Atkins Diet in Persons with Drug-Resistant Epilepsy." This was published in Neurology in March of 2023. Dr. Tripathi is a professor of neurology and epilepsy at the All India Institute of Medical Sciences, where she serves as director of the Epilepsy, Behavioral Neurology, and Sleep Medicine Programs. Dr. Tripathi, it's a pleasure to have you. Dr. Manjari Tripathi (01:57): Hi. Thank you. Great being here. Dr. Adriana Bermeo (02:00): Dr. Cervenka, I want to start with you. Our listeners may or may not be familiar with the concept of ketogenic diets for the treatment of epilepsy in adults particularly, but they may not know that there are different options for treatment. Can you please give us an overview of the principles of these dietary treatments and tell us what options can we can offer to our patients Dr. Mackenzie Cervenka (02:21): In our field? We refer to ketogenic diets for epilepsy actually as ketogenic diet therapies. And we do this to distinguish them from ketogenic diets that we typically hear about being used for weight loss or for other purposes, and that are not necessarily recommended or monitored by clinicians or treating teams. Technically, a ketogenic diet therapy is any dietary manipulation that can produce a state of nutritional ketosis, and that is a state where the body metabolizes fatty acids into ketone bodies. Those are beta hydroxybutyrate, acetoacetate, and acetone. There are a whole variety of ketogenic diet therapies, and these include what are called the classic or classical ketogenic diet. This was first described over one century ago. There are also modified versions of this classic ketogenic diet, specifically the Modified Atkins diet and a modified ketogenic diet. In addition to that, there is a low glycemic index diet or treatment, and that can also produce a state of ketosis, although it is not the primary goal of that particular diet, and any of these diets can be supplemented with medium chain triglyceride oil, and that is readily metabolized into ketone bodies. So that can be added to any of these other diets that I mentioned. Finally, these diets can also be combined with fasting, which also, encourages ketosis as well. Dr. Adriana Bermeo (03:51): Thank you so much, Dr. Tripathi. Do different options fit different demographics? Particularly I'm curious of why did your team choose to try specifically the modified Atkins diet in adults and adolescents with refractory epilepsy as opposed to other options as Dr. Cervenka was describing? Dr. Manjari Tripathi (04:10): So this is a very pertinent question. We need to give something which is acceptable, accessible, and affordable. Now, if you look at the traditional classic ketogenic diet, as Dr. Cervenka described it, it's a very restrictive diet, and it's rigid. It's rigid in terms that it restricts the calories and the fluids. It often requires weighing of food, at least in our center, the ketogenic diet requires the patient to be admitted for a washout and monitoring before the diet is started, whereas a modified Atkins diet does not restrict calories. However, it produces the same effect that is ketosis. So, it's more flexible, it's easier on the gut and the palate, and we know that adults and adolescence can be picky eaters and choosy. As you get older, you also get conditioned on the kind of foods that you eat. So in factoring all this, we decided that it'll be easier on our patients to have the modified Atkins diet, which is less rigid than the ketogenic diet. And hence we undertook the study with drug resistant epilepsy patients as compared to the classic ketogenic diet. Dr. Adriana Bermeo (05:38): Dr. Cervenka, how well accepted do you find these dietary treatments for among patients when you start them on, but also among neurologists and epileptologists? What, what do you think are the greatest barriers right now for them to be used more broadly in the clinic? Dr. Mackenzie Cervenka (05:57): I think it's interesting to look back at kind of the historical perspective of how the ketogenic diet evolved over time, because when it was initially introduced back in the 1920s, it was the only real treatment for epilepsy that was being looked at the time, and it was very popular then. It was being used for children, it was being used for adolescents and adults, and then anti-seizure medications became more readily available around the 1930s, and it really stopped being used for, for many decades, and it sort of reemerged in the late 1900s. However, when it reemerged, it was primarily in children. And so when you ask the question, how accepted is it as a treatment for epilepsy, I think it varies tremendously because I think now if you look in curricula for pediatric neurology residents, you'll see that ketogenic diet therapy is listed in that curriculum for pediatric neurology residents for a treatment of pediatric epilepsy. Dr. Mackenzie Cervenka (07:01): However, that may not necessarily be the case for adult epilepsy. And when I was in training and when I was learning about this I learned about ketogenic diet therapies from my pediatric epilepsy colleagues and wondered why it was not necessarily being used in adults and asked that question of my pediatric and adult colleagues and really did not have a good understanding of why that was the case. So I kind of delved into that a little bit deeper and discovered that there were plenty of epilepsy syndromes and seizure disorders that, that we knew the ketogenic diet was very effective for in children that adults also had. However, they were not necessarily being offered this therapy. And so really it has not been as well accepted in the adult population as it has been in children up until really the last couple of decades, to be honest. Dr. Mackenzie Cervenka (08:01): Now, something else happened that was very interesting, really around2017, and I refer to it as the keto craze, where the ketogenic diet suddenly became very popular for weight loss or different variations on the theme of the ketogenic diet. And I think this brought the concept of a ketogenic diet into the awareness of the general population such that there have even been individuals with epilepsy who started a diet for weight loss and then discovered that it helped with their seizures and began to investigate this and realized, oh, yes, it's been used to treat epilepsy for over a hundred years. So it's, it's a really interest

    27분

  9. 2023. 03. 24.

    Epilepsy Currents – Episode 2 "SUDEP Risk Counseling: What We Don't Do in the Shadows"

    Join Dr. Bermeo in a conversation with Dr. Erik St Louis and Dr. Eugen Trinka as they discuss the article, "SUDEP Risk Counseling: What We Don't Do in the Shadows ". Click here to read the article. This podcast was sponsored by the Danny Did Foundation.

    30분

  10. 2022. 08. 26.

    Epilepsy Currents - Episode 1 "RNS—It Never Gets Old"

    Join Dr. Bermeo in a conversation with Dr. Christopher Todd Anderson and Dr. Dileep Nair as they discuss the article, "RNS—It Never Gets Old". Click here to read the article. This podcast was sponsored by the American Epilepsy Society.

    30분

  11. 2022. 04. 26.

    EPI podcast intro Dr. Bermeo

    Join Dr. Bermeo in a conversation with our contributing editors and the original authors of the literature shaping the field of epilepsy. Epilepsy Currents Podcast will bring you all the features you know and love about the Journal in an innovative format you can take with you wherever you go.

    2분
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Epilepsy Currents Podcasts will bring you all the features you know and love about the journal in an innovative format you can take with you wherever you go. The primary content of Epilepsy Currents consists of commentaries written by our expert editorial board on recent high-impact research papers in Epilepsy. Each podcast episode will highlight one of these recent publications and the accompanying commentary. High-yield topics of interest to our engaged epilepsy community will be presented and discussed by one of our contributing editors and the original authors to give you an in-depth, rigorous, and personal view of current topics in epilepsy and the people behind them. Topics will include both clinical and basic sciences, emphasizing bringing our larger community together around the mission we share: To advance research, education, and practice for all professionals working in epilepsy.

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    Epilepsy Currents